Boosters, Omicron, open borders: How New Zealand's COVID-19 battle is set to change in 2022

2020 was the year COVID-19 arrived in New Zealand and we got used to lockdowns, while 2021 brought the Delta variant and the first vaccines. So what's in store for 2022?

It's already clear Omicron will play a starring role in the coronavirus outbreak's development this year, both on our shores and abroad. The variant appears to be more transmissible but less severe than Delta, presenting a unique challenge for health officials and decision-makers.

Add in the impacts of booster shots, vaccines for five to 11-year-olds and the Government's plan to open our international borders, and 2022 looks to be a year in which our COVID fight changes dramatically.

Omicron arrival 'good and bad news'

Omicron crept up seemingly out of nowhere at the end of 2021, going from a relatively unknown strain to the world's second-most dominant variant behind Delta within weeks.

While Omicron is yet to rear its head in New Zealand's community, it's certainly knocking on the door; dozens of COVID-19 cases have been cropping up in MIQ each day, the vast majority of which the Ministry of Health believes to be Omicron.

Experts Newshub spoke to agree it's just a matter of time before the strain wriggles beyond the border. And they warn when that happens, it'll spread through the country very quickly.

"What we know from looking overseas is that cases can double about every two or three days - and that is extremely, extremely fast," explains infectious disease modeller Michael Plank of Te Pūnaha Matatini and the University of Canterbury.

"I have no reason to think it would be any different here in New Zealand. We can do things to try and slow that down and flatten the curve, but nevertheless I think we need to be prepared to see very large numbers of cases if and when Omicron enters into the community."

Omicron could be predominant in New Zealand within two to four weeks if an outbreak occurs.
Omicron could be predominant in New Zealand within two to four weeks if an outbreak occurs. Photo credit: Getty Images

Dr Amanda Kvalsvig, an epidemiologist and senior research fellow with the University of Otago's Department of Public Health, agrees.

"We currently have a record number of positive cases in MIQ. The MIQ system has so far managed to prevent a major outbreak - a testament to the improved infection control measures and very hard work of the MIQ workforce," she told Newshub.

"But just in terms of the sheer infection pressure, it seems likely that we'll see community transmission soon. Based on what other countries have experienced, if it happens, it'll happen fast."

Overseas, Omicron has proven to be less severe but more transmissible than its predecessor Delta. So as we await its seemingly inevitable presence here, should we be fearful or celebrate?

Prof Plank says it's a bit of a mixed bag.

"It's very much a good news, bad news variant," he told Newshub.

"Of course reduced severity is good, and it's much better than higher severity, which was what we had with Delta. But Delta is a very, very nasty virus, and the fact that Omicron is less severe doesn't mean that it's mild, and it doesn't mean it's harmless.

"It's still causing people to go to hospital and it's still causing deaths. And so because it can spread so quickly, that's the bad news side of the story. You have a phenomenal number of cases, and even a small percentage of that number could still be quite significant."

Dr Kvalsvig says the high transmissibility of Omicron means New Zealand is likely to see higher numbers of people needing medical support than we saw with Delta.

"That’s the challenge of exponential growth. For children in places with high Omicron transmission, it means that although serious complications are rare in terms of percentages, the actual numbers are going up and that is where the impact is being felt."

NZ in race to get vaccines to kids before school year starts

From Monday, Kiwi children aged five to 11 will be eligible to get their first dose of a coronavirus vaccine. COVID-19 Response Minister Chris Hipkins announced the move to vaccinate our tamariki just before Christmas, following approval by MedSafe.

At that time, just under a quarter of the Delta cases in hospital were aged 11 and under. With this group unvaccinated, he warned they were at risk of becoming severely ill, requiring hospitalisation and transmitting the virus to others.

Omicron seems even better at infecting children than the Delta variant. Overseas data shows kids are contracting the virus and being hospitalised at rates faster than ever before, with schools struggling to stay open and serious capacity issues for paediatric services.

Children aged 5-11 are eligible for a COVID-19 vaccine from Monday, January 17.
Children aged 5-11 are eligible for a COVID-19 vaccine from Monday, January 17. Photo credit: Getty Images

Dr Kvalsvig says the kids vaccine rollout here can't come soon enough, especially with a return to school just over a fortnight away.

"Overseas countries are seeing that impacts on children are highly unequal depending on children's underlying conditions, vaccine status and ethnicity," she explained.

"We know exactly the same pattern is likely to be repeated here, so we need to take a proactive approach. That means ensuring that as many children are offered vaccination as possible and that public health protections are in place in schools.

"A particular challenge will be to get adequate school mitigations in place because the start of Term 1 is coming up fast. It will be very hard to address these gaps with an Omicron outbreak in progress, so now is the time to act."

Prof Plank says it's imperative as many of the more than 400,000 children in the five to 11-year-old bracket get the jab before Omicron takes hold, because at the moment, they have no immunity to the virus.

Boosters 'crucial', but masks may need an upgrade

More than 700,000 Kiwis have now had their booster shot to protect them against coronavirus.

The Ministry of Health is strongly recommending boosters for anyone over the age of 18 who had their second vaccine dose at least four months ago - but so far, only about 45 percent of the eligible population have got it.

Prof Plank says getting people their third dose of the vaccine will be another key tool in stopping Omicron from causing widespread devastation once it arrives.

"The third dose of a vaccine is really crucial for Omicron in terms of reducing the risk of hospitalisation," he explained.

"We know that Omicron can spread quickly and cause huge numbers of cases, so keeping those hospital numbers down is really the best hope we have of preventing hospital systems from being overwhelmed."

Data shows there's a significant jump in protection from three doses compared to two. Dr Kvalsvig says a successful rollout could therefore put New Zealand in a strong position to keep people healthy and out of hospital.

Surgical and ckoth masks may no longer be effective enough if Omicron hits.
Surgical and ckoth masks may no longer be effective enough if Omicron hits. Photo credit: Getty Images

But even if the rollout of boosters and vaccines to children go as well as hoped, they're unlikely to go far enough by themselves should Omicron breach the border.

The Government has indicated they will escalate any area with Omicron in the community to the red setting of the traffic light framework. Prof Plank believes that's a good first step, but some additional public health measures may be needed when cases grow and healthcare systems come under pressure.

But our best approach to Omicron is likely to be a slightly different mix of public health measures compared with what's worked in the past, Dr Kvalsvig says.

"Omicron outbreaks move very fast, and there may only be a short period at the beginning where the contact tracing system is able to keep up."

She says an emphasis on preventing virus spread with measures like masks, better indoor air quality and strengthened sick leave provisions will be effective against any variant - including Omicron.

But she warns we may also need to rethink our reliance on cloth and surgical masks.

"An additional protection that is being widely adopted in Omicron outbreaks overseas is a mask upgrade to respirator masks, N95 and similar," Dr Kvalsvig said.

"These masks filter particles more effectively, they fit better around the face than medical masks, and many people find them much more comfortable."

But she says they're currently quite hard to access in New Zealand, it's not easy to establish the quality of what you're buying, and they're expensive for anyone on a low income.

"It would be good to see the Government stepping in to ensure that these more effective masks are widely available, quality-checked, and free to those who are most at risk," she said.

Will we ever return to pre-COVID normality?

The relative normality of 2019 and its days of international travel and maskless shopping feel a world away now.

New Zealand and the rest of the world have been gripped in the COVID-19 pandemic for more than two years - and with Omicron raging on, it could be a long time before it all blows over.

But there are signs we're heading in the right direction, with plans in place to reopen our international borders in phases. We've already opened up an MIQ-free travel corridor with the Cook Islands, and next month will see us do the same with Australia.

Delaying quarantine-free travel with Australia from January 17 to the end of February will buy us some crucial extra weeks to roll out the booster programme and vaccinate five to 11-year-olds, Prof Plank says.

Dr Kvalsvig says there are lots of advantages to loosening border restrictions, but a better approach in 2022 would be to trial a variety of testing and quarantine strategies to protect travellers, the border workforce, and New Zealand as a whole.

"When we have something that works, the numbers can increase. At the moment it's sensible to delay Omicron getting in as long as we can, so we've time to prepare. New-generation vaccines could reduce the border risk substantially, and we may see these new vaccines coming online this year."

As for when we could bid our final farewell to COVID-19?

Prof Plank is hopeful the virus won't be around forever, but warns we may need to get used to the idea of the public health measures we've got now being "built into our daily lives".

"Some of those measures are going to be needed for some time yet," he said.

"What we hope is that the measures that we need are relatively light compared to what we have to put up with in the past - I mean, we really want to avoid putting strict lockdowns again because we know how damaging and disruptive they are.

"Using masks, scanning in with the apps and that sort of thing is hopefully something that people can build into their daily lives, and it doesn't really have too much of a disruptive effect - anything we can use that gets us a better chance of avoiding some of those stricter measures."

Dr Kvalsvig says COVID-19 is a "world-changing event", and thus efforts to return to the days before it existed are misguided.

"Rather than trying to snap back to the 'before' times, we as a country should aim to learn and look forward. For example, we now have a huge amount of knowledge and infrastructure for preventing the spread of infectious diseases," she said.

"What we need now is an intelligent approach to public health that keeps New Zealanders connected and getting on with their lives, with an array of measures working quietly in the background to protect them."

For now, Dr Kvalsvig says New Zealand must make the most of some very important advantages in the looming battle with Omicron, such as the time we have to learn from other countries' responses, our low Delta spread and the ease of ventilation summer warmth brings.

"It's vital that we don't waste these opportunities to protect the health and wellbeing of New Zealanders. We have the opportunity here for a truly world-leading response to this new variant," she says.

"Omicron is clearly very hard to stop, but based on our pandemic track record, if any country can do it, New Zealand can. We won' t know unless we try."